The Potentially Protective Effects of Anti-Lipid, Hypoglycemic, and Anti-Hypertensive Agents for Perioperative Mortality in Geriatric Group

Background Great efforts were made to collect information and identify risk factors in predicting post-anesthetic mortality. In this study, we use national health insurance data base, including medications, underlying comorbidities and surgical factors to assess the relationship between these factors and mortality after surgery. Methods This is a retrospective, population based study. The study population who underwent general anesthesia (GA) were retrieved from the National Health Insurance Research Database in Taiwan between January 1, 2005 and December 31, 2013. We classified the study patients into 4 major comparison groups by surgical procedures, including major organ transplantation (heart, liver, lung, kidney, or pancreas), CV surgery, major neurosurgery, and others according to the diagnostic codes of the international classification of diseases, ninth revision, clinical modification (ICD-9-CM) codes. We proposed a logistic regression model with valuable variables which can significantly predicts the post-anesthesia mortality. We also designed different models for 4 subgroups according the results. Results A total of 833,685 subjects were included in this study, and the most common comorbidity was hypertension. Age was an important determinant associated with post-operation mortality among different surgical types. Perioperative prescription could reduce risks of operation. The prediction model based on the preliminary training group also performed well in the validation group (AUROC=0.8753 for in-hospital mortality; AUROC= 0.8767 for 30-days mortality). A reliable predicting model can help anesthesiologists to decide the anesthesia method or monitors, as well as helping physicians to take care of their patients after operation. Conclusions While GA is commonly used for the majority of the patients undergoing operations, the prediction model that we proposed from this nationwide study could identify the predictors for post-operation mortality. The potentially protective effects of anti-lipid, hypoglycemic, and anti-hypertensive agents were encouraging in geriatric preoperative group. It is expected that applying this prediction model and prescription into clinical practice could improve surgical risk stratification and further improve patient outcomes. Trial registration The protocol of this study was approved by the National Taiwan University Hospital Research Ethics Committee (Trial Registration 201411078RINC). Informed consent was waived by the National Taiwan University Hospital Research Ethics Committee due to the retrospective and anonymous nature of the claims data.